Limitations of somatostatin scintigraphy in primary small bowel neuroendocrine tumors

Abstract Background Somatostatin receptor scintigraphy (SRS; octreoscan) is used in neuroendocrine tumors to locate the primary tumor site and delineate the extent of disease. SRS has decreased sensitivity for small bowel neuroendocrine tumors (SBNETs). The reasons for SRS nonlocalization are not cl...

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Published in:The Journal of surgical research 2014-08, Vol.190 (2), p.548-553
Main Authors: Maxwell, Jessica E., MD, MBA, Sherman, Scott K., MD, Menda, Yusuf, MD, Wang, Donghong, MS, O'Dorisio, Thomas M., MD, Howe, James R., MD
Format: Article
Language:English
Subjects:
Female
Humans
Intestinal Neoplasms - diagnostic imaging
Intestinal Neoplasms - metabolism
Intestinal Neoplasms - pathology
Intestine, Small - pathology
Male
Neuroendocrine Tumors - diagnostic imaging
Neuroendocrine Tumors - metabolism
Neuroendocrine Tumors - pathology
Octreoscan
Radionuclide Imaging
Receptors, Somatostatin - analysis
Receptors, Somatostatin - metabolism
Registries
Retrospective Studies
Small bowel neuroendocrine tumor
Somatostatin scintigraphy
SSTR2 expression
Surgery
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Summary:Abstract Background Somatostatin receptor scintigraphy (SRS; octreoscan) is used in neuroendocrine tumors to locate the primary tumor site and delineate the extent of disease. SRS has decreased sensitivity for small bowel neuroendocrine tumors (SBNETs). The reasons for SRS nonlocalization are not clear. We sought to determine factors that correlate with successful primary tumor localization by SRS in patients with resected SBNETs, and also identify factors that confound interpretation of SRS reports. Methods Records of patients with resected SBNETs were reviewed for SRS results, tumor size, multifocality, N, and M status. Somatostatin receptor 2 ( SSTR2 ) expression was analyzed in resected tumors by quantitative polymerase chain reaction. SRS reports were reviewed and categorized as localizing the primary tumor or not. A nuclear medicine physician independently reviewed available images. Results Of 37 patients with preoperative SRS, the primary tumor was localized in 37%. Of all the factors tested, only small tumor size correlated significantly with SRS nonlocalization. Overexpression of SSTR2 was not significantly different between tumors that were or were not localized by SRS, regardless of tumor size. There were three instances where the SRS report did not agree with the nuclear medicine physician's interpretation as to whether SRS localized the primary tumor. In each case, uptake in mesenteric nodes was a confounding factor. Conclusions SBNETs
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2014.05.031